The Royal College of Pathologists (RCPath) has collaborated with the Royal College of Radiologists and other Medical Royal Colleges and associations to call for reform of multidisciplinary team meetings.
Multidisciplinary team (MDT) working will be increasingly essential as cancer care becomes more complex. However, they need to be improved to effectively enable and empower clinicians to use them as spaces to rethink service design, drive quality improvement, and generate care plans for complex patient cases.
RC Path President Dr Bernie Croal commented: “Multidisciplinary team meetings (MDTM) are crucial but need a radical overhaul. Given the workforce shortages the profession is facing, with 80% of cellular pathologists believing current staffing levels are inadequate to meet growing clinical demand and ensure long-term sustainability of their services, reform is essential to make services more efficient and ensure their focus optimises patient care.”
There is broad buy-in across the cancer care community for such reform and the College has lent its support to a briefing developed by the Royal College of Radiologists in collaboration with the Royal College of Physicians, Royal College of Nursing, and Association of Cancer Physicians, to strongly recommend that the National Cancer Plan commit to reform multidisciplinary team meetings.
Read the multi-society proposals for reforming MDTMs by clicking here.
MDT working is a cornerstone of cancer care, with the weekly meeting its main vehicle. This way of working should enable collaborative, patient centred decision-making as well as a focus on quality improvement, audit and research. But current practice isn’t living up to that promise. Increasingly overloaded meetings are resulting in rushed discussions of variable quality, a heavy time burden for clinicians and even delays to patient care.
Evidence suggests the current way of working is not facilitating equitable access to specialised treatments, despite this being the rationale for introducing MDT working. The National Cancer Audit Collaborating Centre (NatCan), for example, warns that 30% of patients with high-risk prostate cancer do not get access to curative radiotherapy or surgical treatment, with performance varying between 20% and 43% across different services.
It has become established practice for every single patient to be discussed at cancer MDTMs, often more than once. While NHS England has issued guidance to focus discussions only on the more complex patients, this has largely not been adopted.
As demand for cancer care rises, MDTMs need a major redesign to focus on service improvement and reducing the unacceptable variation in access to treatment. MDT working will remain essential to cancer care, but the approach must change to meet the evolving needs of patients. In England, halving the number of patient discussions could save the NHS an estimated £300 million per year.